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Skin Integrity and Pressure Injuries

Cured Rot and Flat Sore Ointment

Eastern cultures often use other naturally occurring herbal remedies for various disease conditions. Arnebia root oil (ARO) is an ancient herbal remedy thought to be useful as an antipyretic, antiseptic and analgesic. It is postulated to promote basic fibroblast growth factor in healing wound tissue in a Chinese study (Pei et al. 2005) but has not been replicated in the SCI population. However, practitioners of traditional Chinese medicine in a Chinese Military Hospital called upon their years of experience with various traditional Chinese medicine remedies when they were not satisfied with the analgesic and curative effect of ARO. They produced a traditional Chinese medicine ointment called cured rot and flat sore ointment (CRFSO) comprised of hydrargyrum oxydatum crudum, red orpiment, borneol, and gypsum fibrosum as a dilutant and treatment of “heat syndrome” according to “yin-yang” theory. Anecdotal observations of superior effects led to a randomized, parallel-group, retrospective trial comparing ARO and CRFSO to treat stage IV pressure injuries in paraplegic patients (Liu et al. 2013).

Author Year
Research Design
Sample Size



Liu et al. 2013
Case Control
Population: Median age: 59.1 yr; Gender: male=19, female= 16; Level of injury: paraplegic=10; Wound status: grade IV ulcer= 35.
Intervention: Patients underwent 28 days of arnebia root oil (ARO) or Chinese herbal formula (CRFSO) treatment after undergoing surgery.
Outcome Measures: Therapeutic effect (healing, effective, improved, no response) and therapeutic duration of treatment.
1. Statistically significant difference (p<0.005) between the two groups (follow-up occurred after 28 days of treatment).
2. No patients had adverse reaction during treatment.
3. Healed: 17 out of 20 patients in the CRFSO group.
4. Healed: 2/11 patients in ARO group.
5. Effective: 2/20 patients in CRFSO group.
6. Effective: 3/11 patients in ARO group.
7. Improved: 1/11 ulcers in ARO group.
8. Therapeutic duration of treatment with CRFSO averaged 19.47 days.
9. Therapeutic duration of treatment with ARO averaged 29.18 days.


Liu et al. (2013) reported that there was a significantly shorter treatment time recorded for CRFSO (19.5±5.0 days) compared to those receiving ARO (29.2±3.2 days; p<0.05). Other aspects of improved outcome included presence of a scab, contractibility, granulation tissue, reduced secretions, and alleviation of pain upon day 28 evaluation. ARO or CRFSO treatments were used in conjunction with sodium chloride cleansing, hydrogen peroxide and saline removal of vesicular, ulcerated and necrotic tissue, 30 minute infrared irradiation of disinfected pressure injuries and surrounding 2-3 cm area, and routine care (e.g., aseptic dressing/bandage changes every 1-2 days) and pain treatment until the ulcers had healed. The ARO group also received 240,000 units of gentamicin gauze wetted with 100ml 9% sodium chloride. CRFSO responses were reported to be better in all categories of outcome assessment versus ARO responses with time to healing as the primary outcome. However, no mention of NPIAP pressure injury documentation guidelines use was mentioned (e.g., drainage amount-scant, moderate, copious), colour/consistency (e.g., serous, serosanguineous, purulent), odor). As well, no stratification for comparison of pressure injury healing by location was provided.


There is level 3 evidence (from one case control study: Liu et al. 2013) that supports the use of CRFSO over ARO to accelerate pressure injury healing but it needs to be noted that objective outcome assessment was not clearly outlined.

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